Alcohol and type 1 diabetes

Can you drink if you have type 1 diabetes? Yes! But if you choose to, it’s critically important that you take certain measures to ensure your safety. The combination of alcohol and diabetes is like boats and icebergs – it’s possible to coexist but one wrong move and the results could be fatal. So here are a few tips and pointers about drinking alcohol with type 1 diabetes:

1. Test, test, test! 

The only way to really know how your body reacts to drinking alcohol is to measure your Blood Glucose (BG) response. Typically, BG will rise but then fall quickly and drastically. 

2. Suss out which drinks work for you…and which don’t.

This one is relatively straightforward. For me, I immediately ruled out sugar filled shots, liqueurs, spirits with regular mixers, cocktails and cider. Spirits with zero sugar mixers should have no impact (if you chose Diet Coke as your mixer, watch the bartender make it where possible – if their thumb hits the top button on the pump, they’re giving you regular coke. This has happened to me countless times. You can also use your BG meter to test your drink, though this doesn’t always work!). Wine tends to be lower in carbs. Beer, not so much.. but depending on the type, sometimes you can get away with one without much of a spike.

3. You may have hypo unawareness

Test regularly… even if you feel fine. You may be hypo and just not realise it – even if your hypo awareness is usually top notch.

4. Glucagon may not work with alcohol induced hypoglycemia

Glucagon works by stimulating your liver to convert stored glycogen into glucose, which can be released into the blood stream and raise blood sugar levels. However, if you drink alcohol, your liver automatically becomes pre-occupied with trying to process and excrete the alcohol. Because of this, your GlucaGen Hypo Kit may not work until your liver has finished this process.

An alternative hypo treatment in the event of severe hypoglycaemia is a form of liquid sugar that can be rubbed into your gums by someone who is aware of  your diabetes.

5. Dawn phenomenon may inhibited

Dawn phenomenon is a normal physiological response that occurs in the early hours of the morning; it’s when the bodies’ release of growth hormones triggers the liver to release glucose in the blood stream. But remember how the liver is already pre-occupied with processing the alcohol? Yep.. depending on the volume of alcohol you’ve consumed, it may well be pre-occupied with clearing your system of that instead.

6. THe production of glucose from non-carbohydrate sources is prevented

Gluconeogensis is a metabolic pathway that results in the generation of glucose from non-carbohydrate substrates. Any guesses where the majority of this process happens? Yes.. once again, it’s the liver.

Because of numbers 4, 5 and 6, you may need to:

7. Consider Reducing your basal

On MDI, I would take half of my normal dose before drinking. If I was going to drink a lot, I’d omit it completely. On the pump, I either set a temp basal or suspend it until morning.

8. The next day

Be prepared for increased insulin sensitivity the following morning/day. If it was a big night, you may need less basal still, or more carbs, or both.

9. Preparation is key.

Eat

Try to never drink on an empty stomach. When it comes to alcohol, protein and carbs are your friends.

Educate

Make sure your drinking friends know the signs of hypoglycaemia and know what to do if you need help.

Carry medical ID

Especially important if you end up alone!